Provider Demographics
NPI:1447278858
Name:WARD, DIANA J (CRNA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10925
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0925
Mailing Address - Country:US
Mailing Address - Phone:865-766-8800
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-664-3301
Practice Address - Fax:843-664-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN913367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1111Medicaid
SCAN1111Medicaid
Q32597Medicare UPIN